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Home My WebLink AboutBLD98-00837 Cancelled Add Pitch Roof and Remodel - BLD Application - 9/23/1998 G� P�-� C /nS O PERMIT NO.: BLD qS q MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATIO Owner 66Wz&- ,1 & oCi, s� Contractor Name r„e„ O Mailing Address Mailing Address -�e6 S T C-T 104- City State Zip Code City — State Zip Code S&3 3 - Phone( Other Ph.( Ph. ther Ph.(� Lien/Title Holder Contractor Reg. # t Address Expiration / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic 4---OConnect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 2 Z.2 / S / aao s"7 Fire District_ Legal Description Site Address(Please include street name, street number and city) Directions to site iae, 73ns, i L Will timber be t and sold in parcel preparation? (Yes/No) S- - Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runciff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Build' Describe Work zz No. of Bedrooms_/ No. of Bathrooms SQ00E FOOTAGE-1 oor 2nd Floor 3rd Floor Loft Basement Deck OtherCoveved DecK- Z'SZ R`sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is aceurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date ,�� , FOR OF . ICIA USE BEYON HIS POINT Accepted by1 �,. Da bmittal Amount Due • Ca Receipt No. DEPARTMENTAL. REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. v-TJ Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ __ _ FEES Building Permit Fee _ 7S Site Inspection Plan Review Fee _Z 1 UFC Plan Review Fee Plumbing & Base Fee 4f oa ZO a0 _ e -41 Mechanical & Base Fee Other ter. Z�-- _A. Wood/Gas/Pellet Stove Fee Other 411 S� Violation Fee Pre-Paid at Submittal }:..4+.:O�ti::n'is4::N�'i::}::::::tti�'t�•:!:ti:�i:::�$::Y:y$�:ii iiii'r:::::':y:{:•,:�:iii :::;x::..:�•:.�. . .:.ry•}}:.::..:: TOTAL FEES {fi:• •iw:{::{;}}:{.gin....:.......:.�::::: :..:.: •. ... A x:;.;r.:;:{:;:ti{.}}.??v:•}i}:;}:•}:i?O:•......n.v.......4}:{?w:::.{ri;jj:.:{:;::::ii:.::.:{i•:+.•}:•}:•}}:::::::::n;y:i:v�iii?iiiiii:}:::::�:4:??.}:• �• � 1_ PERMIT NO.: C �5 MA' ON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION r._ CONTRACTOR INFORMATION Owner , iv ikkta Contractor Name Mailing Address Mailing Address City State Zip Code City ' State %_4 Zip Code 7 Phone( Other Ph.( Ph.(?Zt) ,7-a)c Other Ph.( Lien/Title Holder Contractor Reg. # CZA jL— Address I Expiration c? / / / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. -7 `7 Z / 2/ 0,0 Fire District Legal Description Site Address(Please include street name, street number and city) ,esr.., Directions to site 11,1;, S, '4g"oo - /Idy Is your property within 200' of the following: Body of Water(Name) , Z,/ - Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets ♦ Type of Unit No. of Units Fees Bath Basins / Furnace Bath Tubs / Heatpumps Showers Vent Fans Water Heater _� Propane Tank Laundry Wsher Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other Other Other Base Fee zo Base Fee 2z. TOTAL PLUMBING ;y TOTAL MECHANICAL /5.5 A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X / Date 4 FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. i ::....:::... I .. £JEPARTMEN�1>iiI REV# I[.>::;>::;:::::>::>::::>::>>::r. At?PR�7VED . .. - Qf #rc?iiE ctiAE' ;' ::::::::'::'......... Building Department Occ Group Type Constr. Planning Department Other Other Permit Fee Site Inspection Plan Review Fee / UFC Plan Review Fee Plumbing&Base Fee —r , Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) AL FEES Violation Fee TOT i FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER 222-312- -Ahc7 Date rr SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property lined I I Fadjacent property line I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I adjacent property line-> ' ' E-adjacent property line SAMPLE SITE PLAN adjar�nt property line- 32-0- _ 4. Fadjacent property line D 30' TRI.S.R._ 3041 \ Hone C. I Gaaeou H D I j PriO PasGD 5¢Ift:G �� I. 1 I R\ I VACAN �{T 1 C ARAG.5 \ I I 30' I i I � P0.oPn3CD � I� �\ T A&RZGLL1rIJ0.AL 50 , , I / I I I 60' I \� I I � I \ ' /00 I I � � c.._.eLL I I I I � /DO I i adjacent property lined i \i f adjacent ro ert line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE d,sta„« to rux-t•LAXe- o 4-7� S10pa t c¢ dtia�am Signature Date